An Analysis of the Staub Cranial System

It has now been eight years since a new denture technique from Germany called Staub Cranial was introduced to the U.S.A. in 2007 and then again in 2008. Staub Cranial was nominated by the dental lab technician world as one of ten WOW products of the year. Although it created a big stir then, not much has been heard about it in the past five years. This article has been written to give updated information on this unique procedure. Steve Grass who helped to originally introduce this new product, will give his insight into the pro’s and con’s he experienced as he experimented with this technique over the past 10 years.

First of all, let me define what Staub Cranial is for those readers who are not familiar with it. This is a method of accurately placing denture teeth in the original physiological position. By locating certain bone reference points on stone models, a technician can determine mathematically the individual ideal tooth position. A computer software program outlines the tooth position both on the maxillary and mandibular arches. This eliminates (in theory) the need for the wax bite blocks and allows a full wax try-in on the second patient visit. It also enables the technician to mount and orient the stone working models on a semi-adjustable articulator without the use of a bite registration.

So does it really work? Yes! In my experience, I have found some things that influence the outcome. The following are what I have experienced. In doing full upper and lower cases, approximately 90% of the maxillary arches come back from the wax try-in with few, if any, changes. This is great news!!! The Mandibular arch is a different story. It is set up with the six anterior teeth and posterior wax bite blocks. After the try in and bite registration, almost all of the lower arch set ups come back in a protrusive and lateral excursive position (ie: the lower midline is off and the bite is in a class III tooth position). Our Doctors almost always indicate that the midline is off and a reset of the anterior teeth is prescribed. Since Staub Cranial deals with the ideal tooth position, the lower anterior teeth have been set to that ideal. Even when Dentists spend extra time to get the patient to move closer to a proper centric position, the “acquired bite” usually wins out. When teeth are moved to accommodate this acquired bite, the incorrect position of the teeth causes the Mandibular denture to rock out of the seating position when chewing occurs.

It is certainly nice to have the upper set-up come back without changes needed, however, the frustrations of dealing with the acquired bite still has not been solved. Because of this, many labs who have tried Staub Cranial have now put the equipment on the shelf and gone back to the “old ways,” which is definitely a step backwards. So let’s go back to the main problem: The “acquired bite”.

This problem in our industry came to my attention when my older brother needed dentures. Try as I might, I just could not get my own brother’s dentures to function properly. After several tries, I realized that he had an acquired bite. This did not allow me to get his lower denture to function properly, even though his denture teeth were aligned to the ideal position. In talking to him, I came to realize how his acquired bite came to be. For several years my brother had posterior teeth on one side of his mandible that were hurting him. He started chewing on the opposite side to avoid the pain, and this changed his bite considerably. These same teeth were the first to be extracted, causing a major change again to his chewing habits. As other posterior teeth were extracted, my brother’s bite continued to change. When most of the posterior teeth were extracted, the mandibular arch postured into a protrusive position, causing the remaining upper anterior teeth to flare out, and separate. After all of these changes, an acquired bite became set. The muscles became used to this unnatural positioning, and this literally became the new bite position. The mandible was now in a protrusive and lateral position, rather than centric. This is the cause of the lower midline not lining up with the upper midline. It is also the reason why denture technicians often have to reset the mandibular anteriors on top of, or posterior to, the ridge to obtain an end to end relationship. In this position, function is highly compromised, and the patient will not wear his lower denture.

As mentioned, the Staub Cranial technique places the teeth in an ideal position and does not accommodate this acquired bite relationship. When the clinician takes the centric and vertical bite registration, it often reflects this acquired bite relationship. Dental technicians are then instructed to adjust the teeth from an ideal position to the acquired bite relationship, which compromises proper function and fit.

Fifty years ago, dentistry was not done in this same way. Most of our grandparents who wore dentures had good function, and could chew properly. What was the difference? When our grandparents started having trouble with their teeth, all of their teeth were extracted at once, and they were left toothless for several months to allow for healing. After the ridges healed, impressions were taken and dentures were manufactured. Perhaps the difference was, there was not time for an acquired bite to be obtained. Also,the patient was not fitted immediately with dentures and the muscles had time to adjust back to normal function. So what do we do about this? For the past five years, I have tried to address this very problem. It is difficult to convince the dentist and staff that they have taken a bite registration of the patients acquired bite and not the true centric and vertical bite position. The fact is, the lower midline is not lining up with the upper, because the jaw is not in the proper physiological position. To remedy this, we have to properly identify this acquired position. This needs to be done very accurately, which can take a lot of time and expertise. Most clinicians in our day have not received training to accomplish this task. If we had a way to measure this acquired bite accurately, then compare this with the ideal position (ie.Staub cranial), we could start to adjust the bite back to the ideal. This could be done in increments, like we do with the occlusal adjustment splints used for dentate patients.

There are two items of equipment that are being beta tested that will aide in this measurement. With the advent of digital dentures, this procedure may become possible. I

believe by using Staub Cranial to identify proper tooth position, and then creating a series of bite-adjusting lower dentures, we can finally solve our denture woes. In conclusion, Staub Cranial does provide us with much needed information for ideal tooth positioning. As we are able to accurately identify and measure the acquired bite, we will be able to create a patient treatment plan to correct the acquired bite problem. Digital dentures, in combination with Staub Cranial and bite adjustment procedures, will finally solve our denture woes (in my opinion). As I mentioned, several products are now being beta tested to help this process come about. I have been privileged to work on the development of two of these products, and I look forward to manufacturing dentures this way.

I have written this article in an attempt to reach out to all the labs that originally trained with me in this Staub Cranial procedure, and I hope that it will give some updated information to you. I have kept in contact with Karl Heinz Staub, and we both look forward to the day when we can produce digital dentures with Staub Cranial accuracy. I am now living in Utah, and have my own Denture lab. We are still doing research, and hope to have an intra-oral scanner ttps://drive.google.com/file/d/0B2MjjVht3q6tWFBWTWlya3JUUEU/view?usp=sharing) soon that will further aid in this development. I am also teaming up with other labs to help promote Staub Cranial and expand their clientele base.

Please feel free to contact me for more information. Sincerely, Steve Grass 793 Orchard Drive Pleasant Grove,Utah 84062 steve.gcdt@gmail.com (801)318-1649

PS. We all know how difficult it is to find good denture technicians. We would enjoy teaming up with your lab to help provide quality Staub Cranial restorations. Think of the convenience of having a veteran technician setting up and waxing your cases without having them on payroll and without providing them benefits! Many companies are enjoying these kind of advantages. Isn’t time for your organization to benefit from this kind of arrangement as well Please feel free to contact us to discuss your needs.I have included my current resume to as well as mailing information. We would enjoy doing the first case free.